Factors associated with nonachievement of target blood pressure in patients with chronic kidney disease on antithrombotic therapy

Background: Patients with chronic kidney disease (CKD) can become at risk for thromboembolism and bleeding such as hemorrhagic stroke. The Japanese Society of Hypertension Guidelines for the Management of Hypertension 2019 (JSH2019) recommend that blood pressure (BP) should be cautiously controlled in patients on antithrombotic therapy, with a target value of < 130/80 mmHg to prevent hemorrhagic complications during antithrombotic therapy. Objective: The current study aimed to investigate the achievement rate of target BP, and factors associated with nonachievement of target BP in patients with CKD on antithrombotic therapy. Methods: This cross-sectional study was conducted at an outpatient clinic in 2018. Of 2,427 outpatients who received antithrombotic therapy, patients without CKD, those with CKD stage 5 or on hemodialysis, and those with missing data on body mass index, urinalysis results, and estimated glomerular filtration rate were excluded from the study. Finally, 786 outpatients met the inclusion criteria. Clinical parameters were obtained from the center's electronic database. The office BP value was classified according to the JSH2019 guidelines. The target office BP was set at < 130/80 mmHg in patients with CKD on antithrombotic therapy. The odds ratio (OR) for nonachievement of target BP was calculated via multivariable logistic regression analyses. Results: The majority of patients were on antihypertensive therapy. Calcium channel blockers were the most frequently prescribed drugs, followed by angiotensin II receptor blockers and then diuretics. Acetylsalicylic acid was the most commonly prescribed antithrombotic agent, followed by P2Y12 receptor inhibitors and warfarin. The distribution of BP in this population is 16.2%, 14.1%, 29.1%, 29.5%, 10.1%, and 1.0% had normal BP, high-normal BP, elevated BP, grade I hypertension, grade II hypertension, and grade III hypertension, respectively. Approximately 30% achieved the target BP of < 130/80 mmHg. Multivariable logistic regression analyses indicated that obesity (OR = 1.849, P < 0.001) and proteinuria (OR = 1.846, P < 0.001) were significantly correlated with nonachievement of target BP. Moreover, heart failure and cerebrovascular disease were negatively associated with the nonachievement of target BP. Conclusions: Only a small proportion of patients with CKD on antithrombotic therapy achieved the target BP. Obesity and proteinuria were associated with nonachievement of the target BP in patients with CKD on antithrombotic therapy.